Texas - Revision due to Severe Reactive Hypoglycemia?

RNY 2007 - lost total 150 lbs but have suffered with Severe Reactive Hypoglycemia.

My endocrinologist now poses the question: Pancreatic surgery or revision of your bypass ? 

What is your experience?  Needing suggestions for a revision Dr, who is knowledgeable, patient and doesn't overbook to the point of cattle-call in the North Texas area ? 

Thank you!

well..I used to have severe RH and.. hypoglycemia... and I was lucky to find a great endo and get treated... As we discovered - my hypoglycemia (fasting hypoglycemia) and Severe RH were partially caused by my adrenal insufficiency (AI)

Have They check - did she do a detailed study to see if your adrenals are working ok? we can have primary - secondary or tertiary adrenal insufficiency that could be mild enough not to kill you but enough to mess up your blood sugar levels...  and blood pressure.. and other important stuff in our system..(i.e. food allergies, pain and inflammation..autoimmune stuff.. just to name a few)

app 5 years ago I was diagnosed with secondary AI and the treatment (take steroids during the day) gave me back my life...

Thank you for your reply.  So far, no fasting hypoglycemia.  I am waiting on some antibody bloodwork and possibly a stimulating calcium test to identify the exact source of my problem.  The reaction to carb overload has been purely post-meal, after having gastric bypass in 2007. 

Guess we'll see what comes next. 

Leatha 

A lot of people post op RNY have RH due to carbs overload. Most of us control that by eating lower carbs - moderate proteins and higher fat diet. 

There was a paper published a few years ago that identify that post op RNY we can secret up to 20 times more insulin in response to carbs as compared with normal - non RNY people... 

Knowing that - limiting, but not eliminations carbs - having a balanced meal - can prevent low BS after a meal. 

Since proteins also can stimulate insulin release (Google food insulin index) - my blood sugar can drop if I eat just proteins - I.e. no fat no carb whey isolate shake would make me crash and crash hard. But even adding 5 gr of carbs to that with 5 gr of fat helps stabilize my BS after "a meal". 

I can't eat just carbs as a meal or a snack - I.e. fruits or veggies. I have to make sure there are proteins and fats. So if I want to have a piece of fruit - I make sure I have some cheese or nuts -or nut butters with that. 

It is all about balance. 

Unfortunately once we become so sensitive to carbs - there is no guarantee that reversal would fix anything except make us fat or really sick...As for pancreas surgery- they can never predict how much to remove to fix it - they can take too much - making you a diabetic (and you would have to take insulin for the rest of your life)  - or not enough....Plus any surgery has its own risk... 

(Edited to fix some spelling errors.)

You can control this by diet.  Buggered if I'd let a surgeon near my pancreas.  Almost all of us deal with this for a period, and just have to accept the lifestyle change necessary.

Nobody needs to eat white carbs, how do you manage getting your carbs only from vegetables?   No bread, pasta, rice, fruit, dairy, processed food.  Just meat and vegetables?

I would never get surgery to reduce reactive hypoglycemia.  Pancreatic surgery is extremely serious, and any weight loss revision is also major surgery.  It's hard to find a surgeon who would be willing, and competent, to do it.  You'd likely have to find one who routinely revises to a DS, because even though you wouldn't be getting a DS, they routinely reconstruct the stomach to do the revision. 

I think your answer is already in your post - you only experience it carb loading. We do not need to carb load ever.  Even many high performance athletes now eat a very low carb diet instead of carb loading.  I have a friend who bikes like 300km over hard terrain just eating a very low carb diet, for instance.

The first thing you learn in biochem classes is that the only two essential macronutrients we must consume are protein and fat.  Carbohydrate we do not need to eat.  Several people, such as the Inuit, survived for thousands of years on a very close to zero carb diet and only became obese and diabetic after adopting a Western diet.  Your liver can actually make glucose from protein via a process called gluconeogenesis, and you can make enough to supply the few cells in your brain, your kidneys, and your blood cells that can only use glucose because they have no mitochondria.

I am not suggesting you should eat zero carb by any means.  I am saying though, you might have a doctor and surgery-free means of controlling your hyperglycemia by avoiding high carb foods, which is a good thing. :)

Which works really well when compliant with available foods etc.  It's that one time in the car which could be a horrible disaster, for more than just me.  

SO - since I travel 100% for work, live in and out of hotels and rental cars, there has been that handful of times since 2007 that have become extremely dangerous and terrifying.  

I get what you are saying and is exactly how I have managed up until this point. Unfortunately, I am not exactly perfect, all the time and then there are those times which I THINK I might be okay and may not be and the symptoms now show up at around 43 or less, rather than closer to 70 or 60.   

I do appreciate all you have explained.  I am familiar, just concerned for my future and the safety of others in my path. 

Thank you. 

Leatha

No one is perfect all the time.  I certainly make more than my share of mistakes!

The thing with reactive hypoglycemia is that one time typically won't cause a huge issue.  Even once every 1-2 weeks won't cause an issue.  Our metabolism is not that persnickety.  

I sympathize because I do travel often and I work 12 hour shifts in crisis/ERs and so my eating habits aren't the best either.  Even traveling I always find low carb food, though, no matter where in the world I've been - from Italy to Venezuela.  In America, there are places that serves hamburgers everywhere.  Bunless burger = non-hyperglycemic meal instantly.

Even traveling extensively, there are always options.

Most people are unaware going into it, however the pancreatic surgery you mentioned often permanently causes insulin dependent diabetes in 75-95% of people.  Just be very informed if you go that route.

Whatever you decide works best for you, I hope it works out!

Yes. I am aware of the long term effects of pancreatic surgery.  I have already made it clear that that is not something I am interested in, unless there really is a pancreatic tumor.  I do NOT want surgery induced diabetes.  

I absolutely do not want manslaughter charges, or to harm myself or others that ONE time that it may take to encounter such a problem either.   I am really at an awakening point - perhaps facing unemployment, or drastic changes to put myself in a more controlled environment.  It is not just me, but my employer who could be liable as well.  So - if revision or reversal were a viable option, I might consider it.  

Thankfully, I control things very well MOST of the time, but I have now been in the vehicle, alone, totally blacked out and in seizure mode with blood sugars in the 30's.  It is that ONE time that scares me the most. 

That's absolutely horrible...I am so sorry you have to deal with this decision at all.

And I'd be scared about that one time, too.  Ugh.  I hope they are able to sort it out for you.